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Nurse Practitioner > Gynecologic > Flashcards

Gynecologic Flashcards

1
Q

What tanner stage for women? Areola and nipple project as secondary mound

A

stage 4

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2
Q

What tanner stage for women? Preadolescent breasts

A

stage 1

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3
Q

What tanner stage for women? Breast enlargement without separate nipple contour

A

stage 3

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4
Q

What tanner stage for women? Breast buds with areolar enlargement

A

stage 2

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5
Q

What tanner stage for women? Areola recedes, nipple retracts

A

stage 5

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6
Q

Example of primary amenorrhea

A

Absence of menarche by age 16

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7
Q

Primary or secondary? Cessation of menstrual flow after the establishment of normal menstrual cycling

A

secondary

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8
Q

Absence of menarche, absence of secondary sex characteristics, abnormal growth and development

A

primary amenorrhea

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9
Q

Diagnosis test for amenorrhea

A

pregnancy test, refer to endocrinologist/obgyn, referral for other studies

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10
Q

Risk factors for cervical cancer

A

HPC (early, multiple sexual partners), male partner who has had multiple sexual partners, cigarette smoking, NOT HEREDITARY

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11
Q

BETHESDA classification system

A
  1. ASCUS
  2. Low-grade squamous intraepithelial lesion (LSIL or LGSIL)
    a. Cervical intraepithelial neoplasia (CIN 1): HPV or mild dysplasia
  3. High-grade squamous intraepithelial lesions (HSILor HGSIL)
    a. CIN 2: moderate dysplasia
    b. CIN 3: Severe dysplasia
  4. Carcinoma in situ (CIS)
  5. Squamous cell carcinoma
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12
Q

Management if pap result is: infection

A

treatment based on causative agent; repeat PAP 3-4 months after treatment

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13
Q

Management of ASCUS

A

“watch and repeat”
HPV test, repeat PAP smear

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14
Q

Management of LSIL and up

A

Colposcopy. Refer if CIN 2,3, or CIS

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15
Q

Top Killers of adults in the US

A
  1. Heart disease
  2. Cancer
  3. Unintentional injury
  4. low respiratory disease
  5. CVA
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16
Q

Cancer in women: responsible for the highest mortality?

A

Lung

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17
Q

Cancer in women: leading GYN-associated cancer “killer”

A

Ovarian

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18
Q

Cancer in women: highest incidence other than skin cancer?

A

Breast

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19
Q

Cancer in men: highest mortality?

A

Lung

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20
Q

2nd most common cancer in men and #2 cancer killer?

A

Prostate

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21
Q

Men and women leading cancer killer?

A

Lung

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22
Q

Second leading cancer killer for men and women?

A

Colorectal

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23
Q

when do we stop screening for cervical cancer?

A

> 65 years (for patients with adequate negative prior screening and no history of CIN2 or higher within the last 25 years)

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24
Q

How often do we screen cytology for cervical cancer age 21-29?

A

cytology alone every 3 years. HPV test every 5 years preferred

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25
Q

Patients aged 30-65 years, how often can we do co-testing?

A

Q5 years is acceptable

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26
Q

Inflammation or infection of the vulva and vagina most commonly caused by bacteria, protozoa, and/or fungi

A

vulvovaginitis

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27
Q

Symptom of trichomoniasis in men:

A

often asymptomatic;
malodorous, frothy yellowish-green discharge

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28
Q

what infection? Strawberry patches on cervix and vagina

A

Trichomoniasis

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29
Q

What infection? watery, gra, “fishy” smelling discharge

A

Bacterial vaginosis

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30
Q

What infection? Frothy yellowish-green discharge, pruritus

A

Trichomoniasis

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31
Q

Vulvovaginal erythema with pruritus, thick white curd-like discharge

A

candidiasis

32
Q

what infection? normal caline muxture shows irregularly-shaped vaginal epithelial cells (i.r. clue cells)

A

bacterial vaginosis

33
Q

what infection? KOH mixture show pseudohyphae

A

Candidiasis

34
Q

What infection? potassium hydroxide added to culture produces characteristic odor (i.e. whiff test)

A

bacterial vaginosis

35
Q

what infection? motile trichomonads

A

trichomoniasis

36
Q

Management of trichomoniasis (men and women)

A

Metronidazole (women 500 mg BID for 7 days; men 2 g single dose)

37
Q

What should patients avoid when taking Metronidazole?

A

avoid drinking alcohol

38
Q

Management of bacterial vaginosis

A

Metronidazole 500 mg BID for 7 days OR metronidazole gel 0.75% intravaginally once a day for 5 days OR clindamycin cream 2% intravaginally at bedtime for 7 days

Alternative: Tinidazole 2 grams orally once a day for 2 days OR tinidazole 1 gram orally once daily for 5 days OR CLindamycin 300 mg BID for 7 days OR clindamycin ovules 100 mg intravaginally once at bedtime for 3 days OR Secnidazole 2 grams orally in a single dose, taken with soft food

39
Q

Management of candidiasis

A

OTC intraveginal agents: clotrimazole, miconazole or tioconazole intravaginally or as a vaginal suppository. Precription intravaginal agents: butoconazole or terconazole intravaginally or as a vaginal suppository

40
Q

What are the symptoms of PID?

A

fever/chills, n/v, vaginal discharge, dysuria, dyspareunia, lower abdominal pain, INFERTILITY

41
Q

What finding is positive cervical motion tenderness?

A

PID

42
Q

What finding is adnexal tenderness, abdominal tenderness, fever >38 degress Celsius?

A

PID

43
Q

Diagnostic tests for PID

A

STD testing, elevated ESR or C-reactive protein, ultrasound documentation of ovarian cyst

44
Q

Management of PID

A

Ceftriaxone 500 mg IM in a single dose PLUS Doxycycline 100 mg orally twice a day for 14 days WITH metronidazole 500mg orally twice a day for 14 days

OR

Cefoxitin 2 g IM and probenecid 1 g orally administered together at once PLUS Doxycycline 100 mg orally twice a day for 14 days WITH metronidazole 500 mg orally twice a day for 14 days

45
Q

Cramping pain occurring with menstruation

A

Dysmenorrhea

46
Q

Primary dysmenorrhea

A

occurs in adolescent women as a result of high levels of prostaglandin (pain begins after onset of menses and no pelvic pathology is identified

47
Q

Secondary dysmenorrhea

A

Occurs in women >20 years; more likely associated with some form of pelvic disease

48
Q

Management of primary dysmenorrhea

A
  1. Prostaglandin synthetase inhibitors (start them on NSAID before periods start - ibuprofen, naproxen, indomethacin)
  2. Oral contraceptive pills
  3. Exercise
    D. High fiber diet and reduction of sugar, caffeine and salt
49
Q

Initial approach to vaginal bleeding

A
  1. evaluate for pregnancy
  2. Evaluate for uterine bleeding
    a. non-uterine examples: cervix, vagina, urethra, anus
    b. uterine bleeding indications: 1. coincident with bowel movement and wiping, occurs during or after urination and/or intercourse, is there vaginal, vulvar, perineal, or anal pain/irritation?

If not uterine: conduct pelvic exam
If uterine: determine using PALM-COEIN

50
Q

What does PALM-COEIN stand for?

A

used for abnormal uterine bleeding
polyps, adenomyosis, leoimyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial causes, iatrogenic causes, not yet classified

51
Q

Diagnostic tests for abnormal uterine bleeding

A

hCG (quantitative), prolactin, TSH, CBC, PAP, STD screening, Urinalysis

52
Q

Medical management for PMS/PDD

A

bromocriptine, alprazolam, buspirone, TCA, clomipamine HCL, SSRI,atenolol, oral contraceptive pills, and progesterone

53
Q

Dietary management for PMS, PDD

A

caffeine restriction, vitamin E, salt restriction, vitamin B6, exercise

54
Q

What is abnormal metabolism of androgens and estrogen; results in ovarian cysts?

A

Polycystic Ovary Syndrome

55
Q

What is the most common cause of infertility in women?

A

PCOS

56
Q

Management of PCOS

A

lifestyle changes (diet and exercise), oral contraceptives for menstrual regulation, insulin-sensitizing medication (metformin), hair removal treatment, and acne treatment

57
Q

Management of fibrocystic breast disease

A

warm soaks TID, low sodium diet, vitamin supplements, hormonal therapy, surgical intervention

58
Q

When to being breast cancer screening?

A

May begin by age 40

59
Q

How often to do breast cancer screening?

A

every 2 years after age 50 to 74

60
Q

When to end breast cancer screening?

A

After age 75, if they have quality of life for >10 years, encourage it…with shared decision making

61
Q

Average age of menopause is?

A

51 years, range from 45 to 55 years

62
Q

True or false: menopause can result in atherosclerosis, CAD, osteoporosis, and changes in skin pigmentation

A

true

63
Q

True or false: menopause can result in recurring UTIs and urinary urgency

A

true

64
Q

Management of menopause

A
  1. Estrogen therapy: provides most menopausal symptom relief for patients without a uterus due to a hysterectomy
  2. Estrogen plus progestogen therapy: for women with a uterus to protect against endometrial cancer from estrogen alone
  3. Encourage exercise, calcium supplementation, and health diet
  4. non-hormonal tx of vasomotor symptoms: paroxetine (SSRI), vaginal lubricants and low dose vaginal estrogen
65
Q

Contraindications for hormone therapy (menopause)

A
  1. breast cancer
  2. endometrial cancer
  3. CAD/CHD (including hypertriglyceridemia)
  4. venous thromboembolic disorders
  5. active liver disease
  6. unexplained vaginal bleeding
  7. endometriosis and/or fibroids
66
Q

Top 6 risk factors for osteoporosis

A
  1. female, white, or asian
  2. elderly
  3. early menopause
  4. estrogen deficiency
  5. small frame or underweight
  6. family history
67
Q

What is normal DEXA score

A

T scores > -1.0 SD normal

68
Q

what is osteoporosis DEXA score

A

below -2.5 is osteoporosis

69
Q

What are some dietary sources of calcium?

A

dairy products, sardines, salmon with bones, green leafy vegetables, tofu, calcium fortified foods, take vitamin D (800-1000 IU/day)

70
Q

supplements for osteoporosis

A

most common: calcium carbonate
shoult not be taken with high fiberfoods
avoid aluminum containing antacids

71
Q

Drug therapies for osteoporosis

A

Estrogens, biphosphonates (alendronate, ibandronate, risedronate)

72
Q

instructions for oral administration of biphosphonates

A

take with a full glass of water, NPO 30 minutes to 1 hour, sit upright 30 minutes to 1 hour

73
Q

s/s fever, anorexia, weight loss, butterfly rash, periungual erythema, splinter hemorrhages, alopecia, joint symptoms

A

SLE

74
Q

Laboratory/diagnostics for SLE

A

ANA + in 95% patients
antiphospholipid antibodies
anemia, leukopenia, and thrombocytopenia

75
Q

management for SLE

A
  1. mild symptoms: bed rest, midafternoon naps, avoidanceof fatigue
  2. sun protection
  3. topical glucocorticoid for isolated skin lesion
  4. NSAIDs, hydroxychloroquine, glucocorticoids, and other therapies

Nurse Practitioner (9 decks)

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